Addressing the Racial Disparity in Birth Outcomes: Implications for Maternal Racial Identity on Birthweight Journal of Health Disparities Research and Practice Volume 10 Issue 2 Article 9 © Center for Health Disparities Research, School of Public Health, University of Nevada, Las Vegas 2017 Addressing the Racial Disparity in Birth Outcomes: Implications for Maternal Racial Identity on Birthweight Wanda M. Burton , University of Alabama - Tuscaloosa, [email protected] Maria Hernandez-Reif , University of Alabama Brad Lian , Mercer University Follow this and additional works at: https://digitalscholarship.unlv.edu/jhdrp Part of the Maternal and Child Health Commons, and the Medicine and Health Commons Recommended Citation Burton, Wanda M.; Hernandez-Reif, Maria; and Lian, Brad (2017) "Addressing the Racial Disparity in Birth Outcomes: Implications for Maternal Racial Identity on Birthweight," Journal of Health Disparities Research and Practice: Vol. 10 : Iss. 2 , Article 9. 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Addressing the Racial Disparity in Birth Outcomes: Implications for Maternal Racial Identity on Birthweight Abstract Background: As a widely used marker of health, birthweight has been a persistent racialized disparity with the low birthweight rate of Blacks in Alabama nearly doubling the national average. The purpose of this study was to examine the role of racial identity and acculturation on birthweight in a sample of Black women living in Alabama. Methods: Black women (n=72) in West Alabama were surveyed about the birthweight of their first born child. Correlation and multiple linear regression analyses were conducted. Results: Racial identity was the only significant predictor of birthweight. Mothers with a strong racial identity reported having low birthweight babies less often than those who scored lower on racial identity. Further exploration of racial identity revealed self-image as the essential element that predicted birthweight. Birthweight increased 4.2 ounces for each additional degree of self-image. Results also indicated that birthweight decreased as mothers’ age increased, within the widely accepted optimal maternal age range 21 to 35. Conclusions: Results add to the existing body of literature in support of the positive effects racial identity has on health. Findings on age are congruent with the weathering hypothesis which states that the health of Black women may begin to deteriorate in early adulthood possibly due to the strain of racism. Keywords birthweight; birth outcomes; racial identity; weathering hypothesis Cover Page Footnote The authors thank Dr. Nick Stinnett and Dr. Sara Tomek for their support. Parts of this study has been presented at regional and national conferences. Funding was provided by the Graduate Student Research and Travel Support Fund of The University of Alabama. This article is available in Journal of Health Disparities Research and Practice: https://digitalscholarship.unlv.edu/ jhdrp/vol10/iss2/9 142 Addressing the Racial Disparity in Birth Outcomes: Implications for Maternal Racial Identity on Birth weight Burton et al. Journal of Health Disparities Research and Practice Volume 10, Issue 2, Spring 2017, pp. 142-155 © 2011 Center for Health Disparities Research School of Community Health Sciences University of Nevada, Las Vegas Addressing the Racial Disparity in Birth Outcomes: Implications for Maternal Racial Identity on Birth weight Wanda Martin Burton, MS, CHES, University of Alabama Maria Hernandez-Reif, Ph.D., University of Alabama Brad Lian, Ph.D., Mercer University ABSTRACT As a widely used marker of health, birthweight has been a persistent racialized disparity with the low birthweight rate of Blacks in Alabama nearly doubling the national average. The purpose of this study was to examine the role of racial identity and acculturation on birthweight in a sample of Black women living in Alabama. Black women (n=72) in West Alabama were surveyed about the birthweight of their first born child. Correlation and multiple linear regression analyses were conducted. Racial identity was the only significant predictor of birthweight. Mothers with a strong racial identity reported having low birthweight babies less often than those who scored lower on racial identity. Further exploration of racial identity revealed self-image as the essential element that predicted birthweight. Birthweight increased 4.2 ounces for each additional degree of self-image. Results also indicated that birthweight decreased as mothers’ age increased, within the widely accepted optimal maternal age range 21 to 35. Results add to the existing body of literature in support of the positive effect racial identity has on health. Findings on age are congruent with the weathering hypothesis, which states that the health of Black women may begin to deteriorate in early adulthood possibly due to the strain of racism. Keywords: birthweight; birth outcomes; African American/Black women; racial identity; weathering hypothesis INTRODUCTION In the U.S., low birthweight (LBW) (< 5.5 lbs) is the leading cause of infant mortality in non-Hispanic African American infants (Mathews, MacDorman & Thoma, 2015). Non-Hispanic African Americans will be referred to as Blacks in this paper to denote race. Blacks are disproportionately impacted by high infant mortality rates (Martin et al., 2015). Additionally, there are many developmental outcomes of LBW, including respiratory distress, complications in Journal of Health Disparities Research and Practice Volume 10, Issue 2 Spring 2017 http://digitalscholarship.unlv.edu/jhdrp/ 143 Addressing the Racial Disparity in Birth Outcomes: Implications for Maternal Racial Identity on Birth weight Burton et al. cognitive development and heart disease (Boardman, Powers, Padilla, & Hummer, 2002; Conley & Bennet, 2000). Although national LBW rates for Blacks have remained essentially unchanged over the last few years (Hamilton et al, 2015), in Alabama LBW remains a major cause of concern. While the state average is 10%; for Blacks in Alabama, the LBW rate is 14.6% (Martin, et. al., 2015). Startlingly, the national LBW rate for Blacks in the US (13.15%) is more akin to what UNICEF (2004) reported for underdeveloped countries (13% - 15%) than the overall LBW average for the United States (8.0%) (Hamilton et al., 2015). Term status is a key factor in birthweight, with babies born preterm (before 37 weeks of gestation) at an increased risk of LBW and infant mortality (CDC, 2015). Yet there are several other factors impacting LBW including maternal delivery age, birth order, socio-economic status (Ghaemmaghami et al., 2013; Martin et al., 2015; Mirowsky, 2005), and depression and anxiety (Diego et al., 2006; Diego et al., 2009). The risk of LBW increases with maternal delivery age; between 22 and 35 is suggested as the optimal maternal delivery age (Mirowsky, 2005). Although the relationship between income and birthweight is complicated (Hamad & Rehkopf, 2015), low socioeconomic status (SES) appears correlated to delivering low birthweight babies (Reichman, 2005). A meta-analysis of the impact of maternal depression on LBW concluded that while the relationships is significant, it is complicated by other factors including SES (Grote et al., 2010). Marital status seems to also affect LBW rates with unmarried mothers reporting higher LBW rates (Martin et al., 2011; Ellen, 2000). Being Black is also a significant predictor of LBW (Goldenberg et al., 1996; Hosseini et al., 2009). LBW rates of Blacks exceed the rate of any other reported racial or ethnic group, even when maternal age, educational level and socioeconomic status are taken into account (David & Collins, 1997). The optimal age range for childbearing is more complicated for Blacks. The weathering hypothesis states that the health of Black women may begin to deteriorate in early adulthood as a physical consequence of cumulative disadvantage and this has been suggested as a causal factor in the racial disparity in LBW and infant mortality (Geronimus, 1992; Geronimus, Hicken, Keene, & Bound, 2006). While the cause of LBW may be uncertain, this persistent disparity in birthweight for Blacks versus other racial groups has been noted over the past 40 years despite the efforts of two federally sponsored programs that protect the health of pregnant women and infants: Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and Title V (NIH, 2013). While studies have found that children exposed to WIC tend to have higher birthweight, WIC does not expunge the racial disparity in LBW (Case & Paxson, 2006). Acculturation LBW rates of Blacks exceed the rate of any other reported racial or ethnic group, even when maternal age, educational level and socioeconomic status were taken into account.